Influence Of Peripheral Arterial Disease Research Articles

The influence of peripheral arterial disease on lower limb surface myoelectric signals in patients living with type II diabetes mellitus

BackgroundThe aim of this study was to evaluate whether there are any significant differences in muscle activity between individuals living with type II diabetes mellitus (T2DM) and individuals living with T2DM and peripheral arterial disease (PAD), during gait at a self-selected speed. The influence of different stages of PAD on muscle activity during gait was also assessed with the use of surface electromyography (EMG). Research questionDoes PAD affect lower limb muscle activity during gait in the presence of T2DM? MethodsThis quantitative study involves a prospective, comparative, non-experimental subject design. Ninety participants were divided into three groups namely Group A (thirty participants living with T2DM), Group B(i) (thirty participants living with T2DM and mild PAD) and Group B(ii) (thirty participants living with T2DM and severe PAD). Surface electrode sensors were placed according to SENIAM guidelines, on six main lower limb muscles on both limbs. Muscle activity was recorded using a wireless system, where participants were instructed to walk at a self-selected speed on a 10-m walkway. Average Burst RMS was performed and the amplitude (mV) and the duration of muscle activation (s) was analysed. ResultsThere was a significant increase in muscle amplitude and duration of activation in the presence of lower limb ischaemia during gait. The largest significant difference (p = <0.05) in EMG amplitude and duration of activation when looking at the twelve muscles in general was found between participants living with T2DM and participants living with T2DM and severe PAD. SignificanceThe increase in muscle activity indicates that there are musculoskeletal and biomechanical changes in the lower limb musculature with increasing severity of PAD. Higher muscle exertion demands are required during gait which may result in earlier fatigue. EMG tests would be beneficial for detecting muscle dysfunction objectively and non-invasively in T2DM and PAD.

Cardiovascular events in chronic kidney disease (CKD)—an importance of vascular calcification and microcirculatory impairment

In patients with chronic kidney disease (CKD), particularly in patients with hemodialysis, cardiovascular mortality rate is extremely high. Polyvascular diseases develop at an early stage of CKD. Pathophysiology includes insulin resistance and/or imbalance between nitric oxide (NO) and endothelin bioavailability as well as oxidative stress. Overlooked pathophysiology may be hemorheological disarrangement because of hyperfibrinogenemia, and higher rate of production for monocyte-platelet complexes in circulation, which plays an important role for atherosclerosis. In terms of clinical findings, most of nephrologists have already known about the importance of coronary artery disease, while few of nephrologists are aware of devastating influence of peripheral arterial disease (PAD) on prognosis for the patients with CKD which is known to be one of the independent risk factors for PAD. The understanding in pathophysiology of vascular calcification and strategic treatment is a critical issue to achieve favorable outcome for the patients with CKD. In this regard, FGF-23 and associated factors together with Klotho molecules play an important role. In this article, we aim to review the cardiovascular disease for the patients with CKD with a particular emphasis on the clinical aspects of polyvascular disease. Finally, we address to detect microcirculatory impairment and eradicate vascular calcification as early as possible prior to renal replacement therapy. Apparently, FGF-23-Klotho gene axis as well as vitamin D and phosphate control should be investigated vigorously.

Influence of peripheral arterial disease on daily living activities in elderly women

Aging has been associated with decreases in physical and cognitive functions. Peripheral artery disease (PAD) has been associated with further impairments in these functions, especially in women. However, no detailed information is available indicating whether PAD leads to further impairment in these functions in elderly women. Thus, the aims of this study were 1) to compare the capacity to perform daily living activities between elderly women with and without PAD and 2) to identify the factors related with the performance in daily activities. Twenty-seven elderly women with PAD and 22 elderly non-PAD women were surveyed in a geriatric hospital. Women aged ≥65years and with no signal of dementia were included. PAD was identified by the ankle-brachial index ≤0.90, whereas elderly non-PAD women presented ankle-brachial index >1.0. Patients were interviewed to obtain information regarding basic (Katz questionnaire) and instrumental daily living activities (Lawton-Brody scale) and performed the mini-mental state examination, handgrip strength test, and timed up and go tests. PAD and non-PAD women had similar age, clinical characteristics, handgrip strength test, and cognitive function (P>0.05). The capacity to perform basic and instrumental daily living activities was similar between PAD and non-PAD women (P>0.05). In PAD and non-PAD, the instrumental daily living activities were significantly correlated with cognitive function (r=0.44, P<0.05 and r=0.74 and P<0.05, respectively). PAD elderly women present similar capacity to perform basic and instrumental daily activities than non-PAD women. In addition, in both groups, the capacity to perform instrumental daily activities was related with cognitive function.

English

OBJECTIVES: Peripheral vascular disease is one of the macrovascular complications of diabetes mellitus. The purpose of this study was to examine the peripheral arterial disease (PAD) complicating type 2 diabetes, in particular the influence of PAD on the risk of coronary artery disease. METHODS: Randomly selected T2DM patients admitted to Basaweshwara Teaching and General Hospital were included. In addition to a detailed history and physical examination, anthropometric parameters like body mass index was measured. Relevant laboratory investigations were performed. Modified Rose questionnaire was used to diagnose coronary artery disease (CAD). Colour Doppler examination of the arteries of the lower limbs was performed. A cut off of 7% were significant predictors of PAD. Older age, higher HbA1c levels microalbuminuria and deranged lipid profile were found to be significant predictors of CAD. CONCLUSION: We found evidence of PAD in 16% of type 2 diabetics using ankle brachial index. The prevalence of CAD was higher in patients with PAD. So there is definite and strong correlation between PAD and CAD. Thus the early diagnosis of PAD should alert the clinician to a high probability of underlying CAD.

Influence of peripheral arterial disease and supervised walking on heart rate variability

Influence of peripheral arterial disease and supervised walking on heart rate variability

Influence of peripheral arterial disease and supervised walking on heart rate variability

To examine the influence of peripheral arterial disease (PAD) on heart rate variability (HRV) in patients, and to examine the influence of an intense long-term (12 months) exercise program on HRV in PAD patients. This study involved ambulatory patients attending a local hospital and university center. Participants were twenty-five patients with diagnosed PAD and intermittent claudication and 24 healthy, age-matched adults. Interventions involved random allocation of PAD patients to 12 months of conservative medical treatment (Conservative) or medical treatment with supervised treadmill walking (Exercise). The main outcome measures were time- and frequency-domain, nonlinear HRV measures during supine rest, and maximal walking capacity prior to and following the intervention. Despite significantly worse walking capacity (285 ± 190 m vs 941 ± 336 m; P < .05), PAD patients exhibited similar resting HRV to healthy adults. At the 12-month follow-up, Exercise patients exhibited a significantly greater improvement in walking capacity (183% ± 185% vs 57% ± 135%; P = .03) with similar small nonsignificant changes in HRV compared with Conservative patients. The current study demonstrated that PAD patients exhibited similar resting HRV to healthy adults with 12 months of intense supervised walking producing similar HRV changes to that of conservative medical treatment. The greater walking capacity of healthy adults and PAD patients following supervised exercise does not appear to be associated with enhanced HRV.

Benchmarking healing times for diabetic foot ulcerations and investigating the influence of peripheral arterial disease and infection

Methods Data was collected prospectively between October 2004 and September 2008 for all patients with diabetes who presented with a DFU. All DFU that healed within the time frame of the study were included. Data was collected for the following variables: presentation date, healing date, gender, location, presence of peripheral neuropathy (PN), presence of PAD, presence of infection (STI or OM), and whether the DFU was reviewed on the Multidisciplinary Foot Ulcer Clinic (MDFUC).

Vascular Disease Burden and In-Hospital Outcomes Among Patients Undergoing Percutaneous Coronary Intervention in New York State

Vascular Disease Burden and In-Hospital Outcomes Among Patients Undergoing Percutaneous Coronary Intervention in New York State

Peripheral Arterial Disease Alters Heart Rate Variability in Cardiovascular Patients

Autonomic regulation analysis is useful in risk stratification of ventricular tachycardia and sudden cardiac death in chronic heart failure (CHF). Heart rate variability (HRV) reflects the condition of autonomic regulation. For analyzing the autonomic control the whole cardiovascular system has to be considered. Therefore, the aim of our study was to assess the influence of peripheral arterial disease (PAD) on the autonomic regulation. In 53 men (age: 67 +/- 11 years) from the cardiovascular unit we compared standard HRV parameters in 27 with (ankle brachial index, ABI < 0.9) and 26 patients without (ABI >0.9) PAD as well as with 12 healthy subjects as reference. High-resolution electrocardiograms were recorded over 30 minutes under resting conditions. Pulse wave velocity as well as ABI was estimated using the vascular screening system VASERA. In cardiac patients with PAD, we found both significant differences in linear and nonlinear HRV parameters. Higher increase of low-than high-frequency components indicated higher elevated sympathetic than vagal activation. Altered autonomic control can be interpreted as a compensatory mechanism for diminished vascular arteriolar vasodilator capacity in PAD. To maintain the arterial blood pressure, an elevated setpoint of sympathovagal balance is required. Our data indicate PAD alters the HRV in cardiovascular patients. PAD should be considered in the assessment of cardiac autonomic regulation especially in risk stratification.

Prevalence and Prognostic Influence of Peripheral Arterial Disease in Patients ≥40 Years Old Admitted into Hospital Following an Acute Coronary Event

Objective A significant proportion of patients with ischemic heart disease have associated peripheral arterial disease (PAD), but many are asymptomatic and this condition remains underdiagnosed. We aimed to study the prevalence of PAD in patients with an acute coronary syndrome (ACS) and to evaluate its influence in hospital clinical outcomes. Methods The PAMISCA register is a prospective, multicenter study involving patients ≥40 years old with ACS admitted to selected Spanish hospitals. All patients had their ankle-brachial index (ABI) measured between days 3 and 7 after the ischemic event. Results 1410 ACS patients (71.4% male) were included. PAD determined by ABI was documented in 561 patients (39.8%). Factors independently related to PAD were age (OR: 1.04; 95% CI: 1.03–1.06; p < 0.001), smoking (OR: 1.88; 95% CI: 1.41–2.49; p < 0.0001), diabetes (OR: 1.30; 95% CI: 1.02–1.65; p < 0.05), previous cardiac disease (OR: 1.54; 95% CI: 1.22–1.95; p < 0.001) and previous cerebrovascular disease (OR: 1.90; 95% CI: 1.28–2.80; p < 0.001). Following the ACS, an ABI ≤ 0.90 was associated with increased cardiovascular mortality (OR: 5.45; 95% CI: 1.16–25.59; p < 0.05) and a higher risk of cardiovascular complications. Conclusion The prevalence of PAD in patients ≥40 years presenting with ACS is high and it is associated with increased cardiovascular risk.

Full Length Article

The Influence of Peripheral Arterial Disease on Outcomes: A Pooled Analysis of Mortality in Eight Large Randomized Percutaneous Coronary Intervention Trials Jacqueline Saw, Deepak L. Bhatt, David J. Moliterno, Sorin J. Brener, Steven R. Steinhubl, A. Michael Lincoff, James E. Tcheng, Robert A. Harrington, Maarten Simoons, TingFei Hu, Mobeen A. Sheikh, Dean J. Kereiakes, Eric J. Topol Patients undergoing percutaneous coronary intervention (PCI) frequently have concomitant peripheral arterial disease (PAD). We performed a pooled analysis of 8 randomized PCI trials (EPIC, EPILOG, EPISTENT, RAPPORT, CAPTURE, IMPACT-II, TARGET, and CREDO), evaluating short- and long-term clinical outcomes of PAD patients undergoing PCI. Patients with PAD had higher 7-day, 30-day, and 6-month death or myocardial infarction rates and 1-year mortality. With multivariable analyses, PAD remained an independent predictor of mortality at 30 days, 6 months, and 1 year. We aimed to evaluate clinical outcomes among peripheral arterial disease (PAD) patients following percutaneous coronary intervention (PCI). A significant proportion of patients with coronary artery disease undergoing PCI have concomitant PAD, which may be associated with worse outcomes. We performed a pooled analysis of 8 randomized PCI trials. We included multicenter PCI trials that compared antiplatelet therapies (EPIC, EPILOG, EPISTENT, RAPPORT, CAPTURE, IMPACT-II, TARGET, and CREDO) and had baseline PAD status recorded. Multivariable analyses were performed with stepwise logistic regression for 7- and 30-day outcomes and Cox regression for 6-month and 1-year events. In our pooled analysis of 19,867 patients undergoing PCI, 1,602 (8.1%) were previously diagnosed with PAD. Patients with PAD had higher incidences of 7-day death (1.0% vs. 0.4%; p < 0.001) or myocardial infarction (MI) (6.8% vs. 5.6%; p = 0.047), 30-day death (1.7% vs. 0.7%; p < 0.001) or MI (7.4% vs. 6.1%; p = 0.05), 6-month death (4.2% vs. 1.5%; p < 0.001) or MI (9.1%, vs. 7.7%; p = 0.048), and 1-year death (5.0% vs. 2.1%; p < 0.001). There was a trend toward higher major bleeding risk with PAD (4.8% vs. 3.9%; p = 0.06). With multivariable analyses, PAD remains a significant predictor of mortality at 30 days (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03 to 2.70; p = 0.039), 6 months (HR 1.76, 95% CI 1.31 to 2.37; p < 0.001), and 1 year (HR 1.46, 95% CI 1.08 to 1.96; p = 0.013). The presence of PAD is associated with higher rates of post-PCI death and MI, and is an independent predictor of short- and long-term mortality.

The Influence of Peripheral Arterial Disease on Outcomes: A Pooled Analysis of Mortality in Eight Large Randomized Percutaneous Coronary Intervention Trials

We aimed to evaluate clinical outcomes among peripheral arterial disease (PAD) patients following percutaneous coronary intervention (PCI). A significant proportion of patients with coronary artery disease undergoing PCI have concomitant PAD, which may be associated with worse outcomes. We performed a pooled analysis of 8 randomized PCI trials. We included multicenter PCI trials that compared antiplatelet therapies (EPIC, EPILOG, EPISTENT, RAPPORT, CAPTURE, IMPACT-II, TARGET, and CREDO) and had baseline PAD status recorded. Multivariable analyses were performed with stepwise logistic regression for 7- and 30-day outcomes and Cox regression for 6-month and 1-year events. In our pooled analysis of 19,867 patients undergoing PCI, 1,602 (8.1%) were previously diagnosed with PAD. Patients with PAD had higher incidences of 7-day death (1.0% vs. 0.4%; p < 0.001) or myocardial infarction (MI) (6.8% vs. 5.6%; p = 0.047), 30-day death (1.7% vs. 0.7%; p < 0.001) or MI (7.4% vs. 6.1%; p = 0.05), 6-month death (4.2% vs. 1.5%; p < 0.001) or MI (9.1%, vs. 7.7%; p = 0.048), and 1-year death (5.0% vs. 2.1%; p < 0.001). There was a trend toward higher major bleeding risk with PAD (4.8% vs. 3.9%; p = 0.06). With multivariable analyses, PAD remains a significant predictor of mortality at 30 days (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03 to 2.70; p = 0.039), 6 months (HR 1.76, 95% CI 1.31 to 2.37; p < 0.001), and 1 year (HR 1.46, 95% CI 1.08 to 1.96; p = 0.013). The presence of PAD is associated with higher rates of post-PCI death and MI, and is an independent predictor of short- and long-term mortality.

Peripheral Arterial Disease and Risk of Cardiac Death in Type 2 Diabetes

The purpose of this study was to examine the natural history of peripheral arterial disease (PAD) complicating type 2 diabetes, in particular the influence of PAD on the risk of cardiac death and the adequacy of PAD risk factor management. The Fremantle Diabetes Study (FDS) was a prospective community-based observational study of diabetic patients recruited between 1993 and 1996. The present sample comprised the 1,294 FDS type 2 diabetic patients and a subgroup of 531 of these who had valid data at baseline and five or more subsequent consecutive annual reviews. Assessments consisted of a range of clinical and biochemical variables including the ankle/brachial index (ABI). PAD was defined as an ABI < or =0.90 at two consecutive reviews or any PAD-related lower-extremity amputation. The prevalence of PAD at study entry was 13.6% and the incidence of new PAD was 3.7 per 100 patient-years. Both prevalent and incident PAD was strongly and independently associated with increasing age, systolic blood pressure, total serum cholesterol, and especially smoking. Risk factor management improved but remained suboptimal during follow-up. An ABI of < or =0.90 was independently associated with an increased risk of cardiac death of 67%. Measurement of the ABI is a simple means of identifying PAD in diabetic patients. PAD is common in diabetic patients and predicts cardiac death. These data further support the role of regular screening for PAD in diabetes so that intensive management of vascular risk factors can be pursued.

Influence of peripheral arterial disease on capillary pressure in the foot.

Capillary perfusion and transmural pressure are delicately regulated by microvascular constriction mechanisms, which are activated upon a change in posture. Capillary flow is known to be disturbed in patients with severe peripheral arterial disease. To date, however, the influence of this disease on capillary pressure is unknown. Capillary pressure in the nail fold of the hallux, ankle, and toe blood pressures were measured in the sitting and supine positions in 8 patients with intermittent claudication (F2), in 7 patients with rest pain and/or ischemic ulcers (F3-4), and in 12 age-matched healthy controls (F0). Red blood cell velocity, laser Doppler flux, and continuous blood pressure of the second toe were measured simultaneously. Toe, ankle, and brachial pressure were measured after the experiment in both positions. Capillary pressure did not increase significantly with increasing disease severity (F0, F2, and F3-4) in supine (P =.37; medians, 17, 21, and 14 mm Hg, respectively) and sitting (P =.96; medians, 59, 60, and 60 mg Hg, respectively) positions, whereas toe systolic pressure did, both in supine (P <.001; medians, 91, 49, and 14 mm Hg, respectively) and sitting (140, 104, and 64 mm Hg, respectively) positions. Nutritive skin perfusion (red blood cell velocity) decreased with increasing disease severity (F0, F2, and F3-4) while supine (P =.005; medians,.19,.20, and.04 mm/s, respectively) and while sitting (P =.06; medians,.22,.15, and.04 mm/s, respectively). An increase in orthostatic pressure increases both toe and capillary pressures. Arterial insufficiency of the leg seems to leave the capillary pressure unscathed. Apparently, arteriolar vasodilation compensates for the lower arterial pressure in both positions, even in patients with rest pain and low nutritive perfusion.

Influence of peripheral arterial disease on the initial changes in digital volume during reactive hyperemia.

Influence of peripheral arterial disease on the initial changes in digital volume during reactive hyperemia.